Lesson 4 ECG CVP AND CPR

ARELLANO UNIVERSITY
College of Nursing
PACUCOA Level III Re-Accredited Status
2600 Legarda St., Sampaloc, Manila
www.arellano.edu.ph
STUDENT NAME: _______________________________________________________________________
Class Schedule / Section: ______________________________ Date: _________________________
SKILLS LAB WORKSHEET #3: Pre-Task Activity

LESSON 4: ECG, CVP and BLS - CPR
(60 points)
INSTRUCTION:
1. Word Hunting: Inside the box are 10 words related to the concept of ECG, CVP and BLS - CPR. As you
find the words, shade it and briefly define each in the space provided below:
2. 3-points for every word found; 3 points for every correct definition = 60 points
3. Date of Submission: August 24, 2021
4. Submit your Worksheet#2 at : [email protected]
X E L E C T R O C A R D I O G R A P H Y O
X C V B N M K J H G F D S A Q W E E T Y U
C E N T R A L V E N O U S P R E S S U R E
B A S I C L I F E S U P P O R T W W W E O
U B B N H Y T R E D S W A A Q W S D F S O
N N C A R D I A C A R R E S T C C C C U O
D B B N H Y T R E D S W A A Q W S D F S O
L N E L E C T R O C A R D I O G R A M C O
E B B N H Y T R E D S W A A Q W S D F I O
O N O A S D F T R A N S D U C E R P P T P
F B B N H Y T R E D S W A A Q W S D F A P
H N L B N H Y T R E D S W A A Q W S D T P
I B B N H Y T R E D S W A A Q W S D F I R
S I N O A T R I A L N O D E X X X X X O X
Z X C V B N M M N V C X Z A S D F G H N O
X C V B N M K J H G F D S A Q W E E T Y U
C C E L E C T R O C A R D I O G R A P H O
DEFINITION OF WORDS FOUND: (use additional sheet / page as necessary)
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
Refrain from reproducing this material without the consent of the preparer and the AU-CON
SKILLS LABORATORY MODULE
BASIC NURSING SKILLS ON RESPIRATORY, CARDIO AND HEMATOLOGIC CARE MODALITY
WHILE – TASK ACTIVITY MODULE CONTENT:

LESSON 3 : ECG, CPR and BLS-CPR
I. ELECTROCARDIOGRAPHY (ECG)
A. DEFINITION OF TERMS
• ELECTROCARDIOGRAPHY-
Is a diagnostic procedure performed to record the electrical activity of the
myocardium by placing leads to certain anatomic points on the patient’s
chest/limbs.
• ELECTROCARDIOGRAPH-
The machine used for ECG or EKG determination
• ELECTROCARDIOGRAM-
A graphic record produced by an electrocardiograph
B. USES OF ECG DETERMINATION

• Diagnosis of Myocardial Infarction
• Identification of Abnormal Cardiac Rhythms
• Chamber Hypertrophy
• Pericarditis
• Electrolyte Imbalance
• Evaluation of Cardiac Pacemakers
• Determination of The Effects Of Cardiac Drugs
C. THE NORMAL HEART FUNCTION
D. THE ECG STRIP / PAPER

• Amplitude (voltage) is measured by a series of horizontal lines on the ECG.
• Each horizontal line is 1 mm apart and represents one-tenth of a millivolt (the
basic unit of intensity of the heart’s electrical activity).
• The amplitude of the wave reflects only its electrical force and has no relation to
the muscular strength of ventricular contraction.
• Duration of a wave is measured by a series of vertical lines, also 1 mm apart.

• The time interval between each vertical line is 0.04 second.
E. ELECTROCARDIOGRAPHIC WAVES
• Waveform – movement away from the baseline either positive or negative
• Segment – a line between waveforms
• Interval – a waveform and a segment
• Complex – consists of several waveforms
• Isoelectric line – a place on a normal ECG rhythm that is electrically
neutral. There is nothing electrically happening in the heart at this
particular period.
• Depolarization – contraction of heart muscles
• Repolarization – relaxation of heart muscles
• Arrhythmia (dysrhythmia) – abnormal heart rate, rhythm or ECG wave

configurations.
• P wave – atrial depolarization

• SA node sends electrical impulses to AV node and spreads from RA to LA
• Absence of P wave may indicate:
• Atrial fibrillation
• Sinoatrial block
• Junctional rhythm
• Increased amplitude: hypokalemia or RA enlargement
• Decreased amplitude: hyperkalemia
• Duration: 0.06-0.10 second
• QRS complex – ventricular depolarization

• Q wave – beginning ventricular depolarization
• R wave – depolarization of left ventricle
• S wave – depolarization of right ventricle
• Duration: 08-0.12 second
• Prolonged duration indicates: hyperkalemia or bundle branch block
• Increased amplitude: cardiac hypertrophy
• Decreases amplitude: infarction
• T wave – ventricular repolarization
• Duration : 0.16 seconds
• T-wave inversion (negative T waves) can be a sign of coronary
ischemia, left ventricular hypertrophy, digitalis toxicity, hyperkalemia
or CNS disorder.
• Tall and narrow ("peaked" or "tented") symmetrical T waves may
indicate hyperkalemia
• Flat T waves may indicate coronary ischemia or hypokalemia
• PR interval
• The beginning of the P wave to the beginning of the QRS complex.
• The PR interval reflects the time the electrical impulse takes to travel
from the sinus node through the AV node and entering the ventricles.
The PR interval is, therefore, a good estimate of AV node function.
• Duration: 0.12 to 0.2 seconds
• A long PR interval (of over 0.2 seconds) may indicate a first degree heart
block.
• Prolongation can be associated with hypokalemia, acute rheumatic
fever
• A short PR interval may indicate a pre-excitation syndrome via
an accessory pathway that leads to early activation of the ventricles,
such as seen in Wolff-Parkinson-White syndrome.
• PR segment
• The PR segment connects the P wave and the QRS complex.
• The impulse vector is from the AV node to the bundle of His to the
bundle branches and then to the Purkinje fibers.
• This electrical activity does not produce a contraction directly and is
merely traveling down towards the ventricles, and this shows up flat on
the ECG.
• PR interval is more clinically relevant. Isoelectric
• J wave
• Elevated J-point or Osborn wave appears as a late delta wave following
the QRS or as a small secondary R wave. It is considered
pathognomonic of hypothermia or hypocalcemia.
• J-point
• The point at which the QRS complex finishes and the ST segment begins
• It is used to measure the degree of ST elevation or depression present
• Duration: N/A
• ST segment
• The ST segment connects the QRS complex and the T wave.
• The ST segment represents the period when the ventricles are
depolarized. It is isoelectric.
• Duration : 0.08 to 0.12 seconds
• Elevation or depression of the ST segment indicates an abnormality in
the onset of recovery of the ventricular muscle, usually because of
injury (e.g. acute myocardial infarction).
• ST interval
• Measured from the J point to the end of the T wave.
• Duration: 0.32 seconds
• QT interval
• Measured from the beginning of the QRS complex to the end of the T
wave.
• A prolonged QT interval is a risk factor for ventricular tachyarrhythmias
(or ventricular arrhythmias) and sudden death.
• RR interval
• Interval between an R wave and the next R wave
• Normal resting heart rate : 60 to 100 bpm
• Duration: 0.6 to 1.2s
• U wave
• The U wave is hypothesized to be caused by the repolarization of the
interventricular septum.
• They normally have a low amplitude, and even more often completely
absent. They always follow the T wave and also follow the same
direction in amplitude.
• If they are too prominent, suspect hypokalemia, hypercalcemia or
hyperthyroidism
F. DIAGRAMATIC RELATIONSHIP OF ECG WITH DIASTOLIC AND SYSTOLIC PHASES OF

VENTRICULAR ACTION
G. ECG AND CARDIAC ARRHYTHMIA
• Ventricular Tachycardia
• Fast, but regular heart rhythm
• Ventricular tachycardia is characterized by:
• Absence of P waves
• Wide QRS complexes (usually greater than 0.14 second)
• Rate between 100 and 250 impulses per minute
• First-line treatment:
• Unstable VT - With signs of hemodynamic compromise:
• Hypotension
• Altered Mental Status, though still conscious
• Chest pain
• Cough Cardiopulmonary Resuscitation (C-CPR).
• Use cough CPR, if prescribed, by inhaling deeply and
coughing forcefully every 1 to 3 seconds.
• Cough CPR may terminate the dysrhythmia or sustain
the cerebral and coronary circulation for a short time
until other measures can be implemented.
• Stable VT - No signs of hemodynamic compromise:
• Use of antidysrhytmics:
• Amiodarone (Cordarone)
• Lidocaine (Xylocaine)
• Procainamide (Pronestyl)
• Atrial Fibrillation
• Fast, irregular heart rate
• Atrial fibrillation is characterized by:
• Loss of P waves; an undulating, wavy baseline
• QRS duration that is often within normal limits
• Atrial fibrillation is characterized by:

• Irregular ventricular rate, which can range from 60 to 100 beats
per minute (when controlled with medications) to 100 to 160
beats per minute (when uncontrolled).
• First Line Treatment:
• Carotid sinus massage is one of the maneuvers used for
vagal stimulation to decrease a rapid heart rate and
possibly terminate a tachydysrhythmias.
• Gag reflex and asking the client to strain or bear down.
• Medication therapy often is needed as an adjunct to
keep the rate down or maintain the normal rhythm
• Ventricular Fibrillation
• Fast, erratic heart rate
• Ventricular fibrillation is characterized by:
• Irregular, chaotic undulations of varying amplitudes
• No measurable rate and no visible P waves or QRS complexes and
results from electrical chaos in the ventricles.
• Premature Ventricular Contraction
• Extra, ectopic, abnormal heartbeats
• PVC is characterized by:
• P wave: none
• PR interval: none
• QRS complex: wide and bizarre followed by a compensatory pause (skip
beat)
H. STANDARD CHEST LEAD PLACEMENT (Precordial Leads)
• V1 – 4th ICS just to the right of the sternal border (red)

• V2 – 4th ICS just to the left of the sternal border(yellow)
• V3 – midway between leads V2 and V4 (green)
• V4 – midclavicular line, above 5th ICS space (brown)
• V5 – anterior axillary line at the same level as V4(black)
• V6 – midaxillary line at the same level as leads V4 & V5 (purple)
• Note: Sometimes the 4th intercostal space is difficult to locate; by palpating the
manubrium sterni junction (sternal angle), one can identify the 2 nd interscostal
space. By palpating two ribs inferiorly, the 4th intercostal space may be
identified.
PRE-SELECTED VIDEO FOR THE PROCEDURE:
https://www.youtube.com/watch?v=RYZ4daFwMa8 : Cardiac Conduction System and

Understanding ECG
https://www.youtube.com/watch?v=Rt4kjD4z8vM : 12 Lead ECG Placement of

Electrodes / ECG Sticker Lead Procedure
https://www.youtube.com/watch?v=tuZn65Xet9Q : How to perform a 12 Lead ECG
I. Things to remember when looking at ECG strips

• Are there P waves? If not, the rhythm is irregular, it may be atrial flutter. If the
rhythm is regular and there are no P waves, it may be a junctional rhythm.
• Is the PR interval always the same length? If not, it may be AV dissociation or
forms of 2nd Degree or 3rd Degree AV Block
• Is every P wave followed by a QRS? If not, some form of AV Heart Block is
occurring.
• Is the P wave upright? If not, it may be low atrial or junctional rhythm
II. CENTRAL VENOUS PRESSURE (CVP)
CVP describes the pressure of blood in the thoracic vena cava, near the right atrium of the
heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to
pump the blood into the arterial system.
Central venous pressure is considered a direct measurement of the blood pressure in the
right atrium and vena cava. It is acquired by threading a central venous catheter (subclavian
double lumen central line shown) into any of several large veins. It is threaded so that the
tip of the catheter rests in the lower third of the superior vena cava. The pressure
monitoring assembly is attached to the distal port of a multilumen central vein catheter.
INDICATIONS:
• Assess right ventricular function
• Systemic fluid status
• Rapid infusions
• Infusions of hypertonic solutions and medications that can damage veins
• Serial venous blood assessment
INSERTION SITES:
1. Internal jugular veins
This site is chosen frequently as there is a high rate of successful insertion and a low
incidence of complications such as pneumothorax. Internal jugular veins are short,
straight, and relatively large allowing easy access, however, catheter occlusion may
occur as a result of head movement and may cause irritation in conscious patients.
2. Subclavian veins
This site is often chosen as there are more recognizable anatomical landmarks, making
insertion of the device easier. Because this site is positioned beneath the clavicle there
is a risk of pneumothorax during insertion. A subclavian CVC is generally recommended
as it is more comfortable for the patient.
3. Femoral veins
This site provides rapid central access during an emergency such as a cardiac arrest. As
the CVC is placed in a vein near the groin there is an increased risk of associated
infection. In addition, femoral CVCs are reported to be uncomfortable and may
discourage the conscious patient from moving.
Assisting with CVP placement:
• Adhere to institutional Policy and Procedure.
• Obtain history and assess the patient.
• Explain the procedure to the patient, include:
o local anesthetic
o Trendelenburg positioning
o draping
o limit movement
o need to maintain sterile field.
o post procedure chest X-ray
• Obtain a sterile, flushed and pressurized transducer assembly
• Obtain the catheter size, style and length ordered.
• Obtain supplies:
o Masks
o Sterile gloves
o Line insertion kit
o Heparin flush per policy
• Position patient supine on bed capable of Trendelenburg position
• Prepare for post procedure chest X-ray
PRE-SELECTED VIDEO TO WATCH:

https://youtu.be/cmK3hjJYCKA : Preparation, Insertion and Maintenance of CVC
How to measure the CVP?

The CVP can be measured either manually using a manometer and electronically using a
transducer. In either case the CVP must be “zeroed” at the level of the right atrium. This
is usually taken to be the level of the 4th intercoastal space in the mid-axillary line while
the patient is lying supine. Each measurement of CVP should be taken at this same zero
position.
1. Using the Manometer

A 3-way tap is used to connect the manometer to an intravenous drip set on one side,
and via extension tubing filled with intravenous fluid, to the patient on the other. It is
important to ensure that there are no air bubbles in the tubing, to avoid administering
an air embolus to the patient. You should also check that the CVP catheter tubing is not
kinked or blocked, that intravenous fluid can easily be flushed in and that blood can
easily be aspirated from the line. The 3-way tap is then turned so that it is open to the
fluid bag and the manometer but closed to the patient, allowing the manometer column
to fill with fluid. It is important not to overfill the manometer, so preventing the cotton
wool bung at the manometer tip from getting wet. Once the manometer is filled
adequately the 3-way tap is turned again-this time, so it is open to the patient and the
manometer but closed to the fluid bag. The fluid level within the manometer column
will fall to the level of the CVP, the value of which can be read on the manometer scale
which is marked in centimeters, therefore giving a value for CVP in centimeters of
water. The fluid level will continue to rise and fall slightly with respiration and the
average reading should be recorded.
2. Using the Transducer
The transducer is fixed at the level of the right atrium and connected to the patients CVP
catheter via fluid filled extension tubing. Similar care should be taken to avoid bubbles
and kinks as mentioned above. The transducer is then ‘zeroed’ to atmospheric pressure
by turning its 3-way tap so that it is open to the transducer and to the room air but
closed to the patient. The 3-way tap is then turned so that it is now closed to room air
and open between the patient and the transducer. A continuous CVP reading measured
in mmHg rather than cmH2O, can be obtained.
EQUIPMENT:
• Venous pressure tray
• Cut-down tray
• Infusion solution and infusion set
• 3-way or 4-way stopcock (a pressure transducer may also be used)
• IV pole attached to bed
• Arms board
• Adhesive tape
• ECG monitor
• Carpenter’s level (for establishing zero point)
PRE-SELECTED VIDEO FOR CVP MEASUREMENT:

https://youtu.be/YEsXlpwtljw CVP Measurement
INTERPRETING MEASUREMENTS:
The normal range for CVP is 5-10cm H2O (2-6mmHg) when taken from the mid-axillary
line at the fourth intercostal space. Many factors can affect CVP, including vessel tone,
medications, heart disease and medical treatments. A CVP measurement should be
viewed in conjunction with other observations such as pulse, blood pressure and
respiratory rate and the patient’s response to treatment
POTENTIAL COMPLICATIONS:
• Hemorrhage from the catheter site - if it becomes disconnected from the
infusion. Patients who have coagulation problems such as those on warfarin or
those will clotting disorders are at risk.
• Catheter occlusion, by a blood clot or kinked tube - regular flushing of the CVC
line and a well secured dressing should help to avoid this.
• Infection - redness, pain, swelling around the catheter insertion site may all
indicate infection. Careful asepsis is needed when touching a CVC site. Swabs for
MC&S should be taken if infection is suspected.
• Air embolus - if the infusion or monitoring lines become disconnected there is a
risk that air can enter the venous system. All lines and connections should be
checked at the start of every shift to minimize the risk of this occurring.
• Catheter displacement - if the CVC moves into the chambers of the heart then
cardiac arrhythmias may be noted, and should be reported. If the CVC is no
longer in the correct position, CVP readings and medication administration will
be affected.
SPECIAL CONSIDERATIONS:
Teaching
• Instruct patient to report discomfort around the site; discomfort in arms,
shoulders, or side of the neck; or any shortness of breath.
• Discuss and provide written emergency measures and telephone numbers
of health care personnel to be used in case of catheter damage,
displacement, swelling, redness, or leakage at insertion site; occlusion of
port or catheter; temperature above 100.4° F (38° C) (see agency policy);
and shaking chills.
• Provide written instruction for dressing changes, inspection of insertion site,
flushing, and tubing changes.
• Arrange for instruction and return demonstration of skills by patient or
family caregiver.
• Have patient or family caregiver maintain a list of caregivers and telephone
numbers (e.g., physician, nurse, social worker, pharmacist, dietitian).
III. BASIC LIFE SUPPORT – CARDIO PULMONARY RESUSCITATION (BLS-CPR)
According to recent statistics sudden cardiac arrest is rapidly becoming the leading
cause of death.
Once the heart ceases to function, a healthy human brain may survive without oxygen
for up to 4 minutes without suffering any permanent damage.
Unfortunately, a typical EMS response may take 6, 8 or even 10 minutes to arrive
It is during those critical minutes that CPR (Cardio Pulmonary Resuscitation) can provide
oxygenated blood to the victim's brain and the heart, dramatically increasing chance of
survival.
And if properly instructed, almost anyone can learn and perform CPR.
A. BASIC LIFE SUPPORT (BLS)

• Refers to the care healthcare providers and public safety professionals provide
to patients who are experiencing respiratory arrest, cardiac arrest or airway
obstruction.
• BLS includes psychomotor skills for performing high-quality cardiopulmonary
resuscitation (CPR), using an Automated External Defibrillator (AED) and
relieving an obstructed airway for patients of all ages
• COMPONENTS OF BLS
• Ensure safety
• Check for response
• Activate EMS (emergency medical service)
• Chest compressions
• Check airway and ventilate
• Defibrillate
B. CARDIAC ARREST
• If there is no breathing, no pulse and the patient is unresponsive, the patient is

in cardiac arrest.
• Cardiac arrest is a life-threatening situation in which the electrical and/or

mechanical system of the heart malfunctions resulting in complete cessation of
the heart’s ability to function and circulate blood efficiently.
C. CAUSES OF RESPIRATORY / CARDIAC ARREST

• CARDIAC CAUSES:
• M.I.
• Heart Failure
• Dysrhythmia
• Cardiac Tamponade
• PULMONARY CAUSES:
• Airway Obstruction
• ARDS
• Pneumothorax
• Pulmonary Embolism
• Respiratory Failure
• ELECTROLYTE IMBALANCE
• Hyperkalemia
• Hyper / Hypo calcemia
• OTHER CAUSE:
• Hypersensitivity Reaction
• Drug Toxicity
D. CHAIN OF SURVIVAL
E. CHAIN OF SURVIVAL AS A UNIVERSAL CHAIN THAT ALREADY IMPLEMENTED ARE

CONSIST OF :
• Immediate recognition of cardiac arrest and activate of emergency response
system.
• Early CPR that emphasizes chest compressions (new guidelines AHA 20120).
• Rapid defibrillation if indicated.
• Effective advanced life support.
• Integrated post-cardiac arrest care.
F. RESCUER & VICTIM

• Rescuer – ALL, regardless of training, can provide chest compression to a Victim
– who may be in danger.
• Untrained – Hands Only CPR
• Trained – CC ± rescue breaths
• Health Care Provider – CC + rescue breaths, coordinate teamwork
G. RESPIRATORY ARREST
• If the patient is not breathing but has a definitive pulse, the patient is in
respiratory arrest.
• To care for a patient experiencing respiratory arrest, ventilations must be given.
H. CARDIOPULMONARY RESUSCITATION (CPR)
• A first aid technique to help people who suffer “cardiac arrest”

• It involves doing chest compressions and rescue breaths to keep the patient
alive until a defibrillator arrives.
• A defibrillator is an electrical device which can be used to help restart
someone’s heart.
• CPR on its own is unlikely to restart someone’s heart, however it will increase
the chance of a defibrillator being successful.
• If you find someone collapsed, you can use DR S CAB to help you remember
what actions to take.
• Danger
• Response
• Seek Help
• CIRCULATION / Early COMPRESSION
• Airway
• Breathing
• Danger
• Ensure safety of SELF and the VICTIM:
• Hazards / Risks
• Bystanders
• Only enter a situation if it is safe to do so. Remember, you are the most
important person.
• Move victim – only when absolutely necessary [unstable cervical spine
– injured spinal cord]
• Response / Seek Help
• Position victim on firm surface
• Kneel beside victim's chest or stand beside bed
• Ask the victim “Are you ok ?”
• Tap and shout
• If the victim responds, SEEK help, reassess the condition further
• If the victim did not respond, he is unconscious, SEEK help activate EMS.
Do not leave the victim
• CIRCULATION / Early CHEST COMPRESSION
1. CIRCULATION
• Check pulse. If pulse is not definitely felt proceed with chest
compressions.
• Position of victim
• Must be supine on a firm flat surface for CPR to be effective
• Victim lying facing down – logroll the victim
2. Render initial, 30 chest compressions

• Heel of one hand on inter-mammary line (which is the lower
half of the sternum)
• Heel of other hand on top of the first so that the hands are
overlapped and parallel. Interlock fingers
• Lock elbows
• Push down to a depth of 5 – 6cm
• Push down 30 times at a rate of 100 - 120 compressions / min
• Rhythmic applications of compression increase intrathoracic
pressure and directly compress heart
• Ensure you release fully after each compression. Do not ‘lean’
on the victim’s chest
• AIRWAY
• To ensure effective rescue breath, airway should be free from
obstruction
3. Open an unconscious patient’s airway, place one hand on their forehead

and tilt their head backwards.
• Place two fingers on the bony part of their chin and lift it.
• This is known as the “head tilt, chin lift” maneuver
• Jaw Thrust Maneuver
• BREATHING
• No “look, listen, feel” for signs of breathing in new guidelines.
• After the first set of chest compressions (5 cycles: 1 cycle is 30
compressions), the airway is opened and the rescuer delivers 2 breaths.
4. GIVING RESCUE BREATHS
• Use a barrier device of some type while giving breaths.
• Deliver each rescue breath over 1 second.
• Give a sufficient tidal volume to produce visible chest rise (500- 600ml).
• Avoid rapid or forceful breaths.
• When an advanced airway is in place during 2-person CPR, ventilate at a
rate of 8 to 10 breaths per min.
• METHODS OF RESCUE BREATHS

• Mouth-to-Mouth Rescue Breathing
• Mouth-to–Barrier Device Breathing
• Mouth-to-Nose and Mouth-to-Stoma Ventilation
• Ventilation With Bag and Mask
• Ventilation With an Advanced Airway
• CHARACTERISTICS OF GOOD CPR

• “Push hard push fast”.
• Push at a rate of 100-120 min.
• Compression depth- at least 2 inches(5cm) not more than 2.5
inches
• Release completely to allow the chest to fully recoil.
• A compression-ventilation ratio of 30:2 / cycle
• Accomplish 5 cycles prior to reassessment.
• Do not be a:
• Bouncer
• Bender
• Massager
• Double Crosser
• Use the heel of your hand.
• CHEST COMPRESSIONS
• When 2 or more rescuers available
• Switch the compressor about every 2 minutes (or after 5 cycles
of compressions and ventilations at a ratio of 30:2).
• Accomplish this switch in ≤5 seconds.
• Advanced airway and 2 rescuers- • Continuous chest
compressions at a rate of 100-120 /min without pauses for
ventilation.
• The rescuer delivering ventilation provides 8 to 10 breaths per
minute.
• Lay rescuers should continue CPR until an AED arrives
I. EARLY DEFIBRILLATION
• AED – Automatic External Defibrillator

• A battery-operated device
• Detects and assesses cardiac rhythm and prompts the user for further
action
• AED BOX contains –
• AED machine with battery and charger
• Two self-sticking pads with cables connectors one razor
• AED MACHINE
• On/Off switch
• Plug with flashing light near it
• Shock delivery button(orange)
• Speaker & volume control for voice prompt
• Battery
• Give ONE shock each time AED advises “SHOCK”

• Resume CPR immediately- 5 cycles (2 min ) starting with chest
compressions
• After 2 minutes, AED will automatically start analyzing again &
prompt accordingly
• Non-shockable rhythm- AED prompts to check for “signs of
circulation” - Check Pulse (< 10sec) a)
• No pulse : continue CPR
• Pulse : discontinue CPR
• DEFIBRILLATION SAFETY
• PATIENT - 5-point check
• Pacemaker
• Jewelries
• Hair on chest
• Damp/Wet skin
• Patches (NTG)
• AED
• In good working order
• Do Not use in Heavy rain
• Do Not use if they lay in a pool of water
• Do Not use in an explosive environment
J. CONTINUE RESUSCITATION UNTIL

• Qualified help arrives and takes over
• Victim revives: The victim starts breathing normally
• Rescuer becomes exhausted
K. THE RECOVERY POSITION

• LEFT LATERAL RECUMBENT POSITION
• If the victim responds, position him in the recovery position and monitor
breathing until help arrives.
PRE-SELECTED VIDEO FOR CPR:

https://www.youtube.com/watch?v=CD5X4FyB6qE : Adult AED
https://www.youtube.com/watch?v=msRft-g-k_s : CPR / AED Emergency Response
L. BLS DIFFERENCES
Key changes and continued point of emphasis from 2005 BLS Guidelines (AHA) include the following:
1. Immediate recognition of Sudden Cardiac Arrest based on assessing unresponsiveness and
absence of normal breathing (victim is no breathing or only gasping).
2. Look, Listen, and Feel removed from the BLS algorithm.
3. Encouraging Hands-Only (chest compression only) CPR for untrained lay-rescuer (continuous
chest compression over of the middle of the chest)
4. Sequence change to chest compression before rescue breaths (CAB rather than ABC)
5. Health care providers continue effective chest compression/CPR until return of spontaneous
circulation (ROSC) or termination of resuscitative efforts.
6. Increase focus on methods to ensure that high quality CPR (compression of adequate rate and
depth, allowing full chest recoil between compressions, minimizing interruptions in chest
compression and avoiding excessive ventilation) is performed.
7. Continued de-emphasis on pulse check for health care providers.
8. A simplified adult BLS algorithm is introduced with the revised traditional algorithm.
9. Recommendation of simultaneous, choreographed approach for chest compression, airway
management, rescue breathing, rhythm detection, and shocks (if appropriate) by an integrated
team of highly-trained rescuers in appropriate settings.
POST-TASK ACTIVITY
1. QUIZ – Link will be sent by the Clinical Instructor after the video presentation
2. VIDEO RECORDED and PRESENTATION of BASIC NURSING SKILLS and PROCEDURES on:
a. ECG Lead Placement
b. CVP Monitoring
c. CPR
INSTRUCTIONS:
a. After studying and reviewing Lesson 4 Module, the students are tasks to demonstrate the basic
nursing skills and procedures through a graded video-recorded role playing. The skills shall cover
care modalities on patients undergoing ECG Lead Placement, CVP Monitoring and CPR.
b. The length of the video that will cover the three care modalities shall not exceed 40 minutes.
c. RUBRICS or SKILLS CHECKLIST and PEER / GROUP EVALUATION on how each student are to be
graded will be as follows:
PART I: SKILLS CHECKLIST ON CARE MODALITIES:

ECG Monitoring / CVP Monitoring
ASSESSMENT CRITERIA CD ID ND REMARKS

(2) (1) (0)
SKILL BASED CRITERIA
I. PRE-PROCEDURE PHASE
1. Checks Doctor’s order
2. Verifies the right client for the procedure
3. Prepares all the necessary supplies and
equipment
4. Introduces self to client
5. Explains the procedure to the client
6. Assess / re-assess client’s need for the
procedure
7. Entertains queries from the client
8. Performs hand washing
9. Dons PPEs
10. Keeps room well lighted and warm
II. PROCEDURE PHASE
1. Observes privacy by closing doors and curtains
2. Conducts procedure in chronological
sequence
3. Assists clients in assuming various positions
necessary for the procedure
4. Involves client with the procedure by giving
clear instructions or coaching
5. Observes client’s reaction / response to
procedure
6. Maintains proper posture and body
mechanics while performing procedure
7. Maintains IPR with client during the
procedure
8. Doffs PPE
III. POST PROCEDURE PHASE
1. Assists client in assuming position of comfort
after the procedure
2. Evaluates client’s response to the procedure
3. Performs after care
4. Washes hands
5. Documents procedure and significant
observations
KNOWLEDGE BASED CRITERIA
• Narrator:
1. Explains essential points in the presentation
2. States rationale as needed
3. Clear and logical structure of presentation
4. Summarizes major points of the presentation
5. Identifies indications/ contraindications of
nursing actions
6. Uses appropriate terminologies accordingly
• Members:
1. Answers questions post-video presentation
2. Offers additional information post-video
presentation
ATTITUDE BASED CRITERIA
1. Compliance
o Length of presentation within the
assigned time limits
o Observed due date
o Followed other essential instructions
2. Creativity
3. Resourcefulness
4. Cooperativeness
5. Enthusiasm and Eagerness to learn
6. Appearance (decency and appropriateness
e.g. proper uniform)
PROCEDURAL POINTS 74
PART II: SKILLS CHECKLIST ON CARE MODALITIES:
BLS-CPR: ADULT
ASSESSMENT CRITERIA CD ID ND REMARKS

(2) (1) (0)
SKILL BASED CRITERIA
1-Responder Adult CPR
1. Check for any signs of danger to:
a. The rescuer
b. The victim
c. The Surroundings
2. Check for the victim’s responsiveness
3. Call for help, activate the emergency response
system and sends for an AED
4. Check for Circulation
a. Check pulse. If pulse is not definitely
felt proceed with chest compressions
b. Position the patient in a supine, firm
flat surface
c. Render initial, 30 chest compressions
at 100 compression / minute
d. Heel of one hand on inter-mammary
line (which is the lower half of the
sternum)
e. Heel of other hand on top of the first
so that the hands are overlapped and
parallel. Interlock fingers
f. Push down to a depth of 5 – 6cm
g. Push down 30 times at a rate of 100 -
120 compressions / min
h. Applied rhythmic compression
directly over the sternum
i. Releases compression completely
allowing the chest to fully recoil
j. Render first set of chest compression
(5cycles: 1 cycle = 30 compression)
5. Deliver 2 rescue breath
a. Open an unconscious patient’s
airway, using the “head tilt, chin lift”
maneuver
b. Open an unconscious patient’s
airway, using the “Jaw Thrust”
maneuver as necessary
c. Remove any visible obstruction in the
mouth
d. Deliver each rescue breath over 1
second
6. Deliver 5 cycles of high-quality CPR
7. Use AED as soon as it’s available on the scene
a. Turns on the AED to charge
b. Place paddings on victim’s chest
(directly to skin)
c. Keeps distance from the patient as
AED is analyzing and until shock is
delivered
d. Continue CPR for 2 minutes
e. Repeat delivery of shock as needed
f. Reassess patient for return of
spontaneous circulation
8. Successfully recovers spontaneous circulation
9. Stops CPR and give 2 rescue breaths
10. Position patient to recovery position
11. Continue monitoring ABCs
12. Wait for EMS to arrive
KNOWLEDGE BASED CRITERIA
• Narrator:
1. Explains essential points in the presentation
2. States rationale as needed
3. Clear and logical structure of presentation
4. Summarizes major points of the presentation
5. Identifies indications/ contraindications of
nursing actions
6. Uses appropriate terminologies accordingly
• Members:
1. Answers questions post-video presentation
2. Offers additional information post-video
presentation
ATTITUDE BASED CRITERIA
1. Compliance
a. Length of presentation within the
assigned time limits
b. Observed due date
c. Followed other essential instructions
2. Creativity
3. Resourcefulness
4. Cooperativeness
5. Enthusiasm and Eagerness to learn
6. Appearance (decency and appropriateness
e.g. proper uniform)
PROCEDURAL POINTS 88
LEGEND:
CD – Correctly Done / Displayed / Demonstrated
ID – Incorrectly Done / Slightly Displayed / Slightly Demonstrated
ND – Not Done / Not Displayed / Not Demonstrated
Performed by: Evaluated by:
______________________________ ________________________________
Block and Group Clinical Instructor’s Name and Signature
PART III: PEER - GROUP EVALUATION
Instruction: Each member will rate each other including yourself according to the following rating scale:
1- Not executed
2- Poorly executed
3- Averagely executed
4- Excellently executed
Name Participation Cooperation Quality of Work TOTAL

(in planning & (interest, (Value & worth (12)
developing enthusiasm, of work output)
ideas) interest)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Note:
• Do not fill -up Part I and Part II-Skills Checklist Evaluation Form. That is for your Clinical Instructor’s guide
on how to rate you on your Video Output
o Skills Checklist Evaluation Forms are presented to the students to serve as guide as to how
students will be graded
• Part III: Peer Group Evaluation Form is for you to fill up. Submission is after the video class presentation
• Clinical Instructor will add your individual overall rate for peer group evaluation to Part I Rating
• TOTAL EXPECTED PERFECT SCORE: 248 POINTS
o Part I = 148 (74 points x 2 Basic Skills / Procedures: ECG and CVP Monitoring)
o Part II = 88 points (CPR)
o Part II = 12 points
• This is Prelim Culminating Activity for the group assigned to prepare a video demo

Lesson 4 ECG CVP AND CPR

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ARELLANO UNIVERSITY

STUDENT NAME: _______________________________________________________________________

Class Schedule / Section: ______________________________ Date: _________________________

SKILLS LAB WORKSHEET #3: Pre-Task Activity

DEFINITION OF WORDS FOUND: (use additional sheet / page as necessary)

WHILE – TASK ACTIVITY MODULE CONTENT:

B. USES OF ECG DETERMINATION

D. THE ECG STRIP / PAPER

• Duration of a wave is measured by a series of vertical lines, also 1 mm apart.

• Depolarization – contraction of heart muscles

• Repolarization – relaxation of heart muscles

• Arrhythmia (dysrhythmia) – abnormal heart rate, rhythm or ECG wave

• P wave – atrial depolarization

• QRS complex – ventricular depolarization

F. DIAGRAMATIC RELATIONSHIP OF ECG WITH DIASTOLIC AND SYSTOLIC PHASES OF

G. ECG AND CARDIAC ARRHYTHMIA

• Atrial fibrillation is characterized by:

H. STANDARD CHEST LEAD PLACEMENT (Precordial Leads)

• V1 – 4th ICS just to the right of the sternal border (red)

https://www.youtube.com/watch?v=RYZ4daFwMa8 : Cardiac Conduction System and

https://www.youtube.com/watch?v=Rt4kjD4z8vM : 12 Lead ECG Placement of

https://www.youtube.com/watch?v=tuZn65Xet9Q : How to perform a 12 Lead ECG

I. Things to remember when looking at ECG strips

PRE-SELECTED VIDEO TO WATCH:

How to measure the CVP?

1. Using the Manometer

PRE-SELECTED VIDEO FOR CVP MEASUREMENT:

Unfortunately, a typical EMS response may take 6, 8 or even 10 minutes to arrive

A. BASIC LIFE SUPPORT (BLS)

• If there is no breathing, no pulse and the patient is unresponsive, the patient is

• Cardiac arrest is a life-threatening situation in which the electrical and/or

C. CAUSES OF RESPIRATORY / CARDIAC ARREST

E. CHAIN OF SURVIVAL AS A UNIVERSAL CHAIN THAT ALREADY IMPLEMENTED ARE

F. RESCUER & VICTIM

• A first aid technique to help people who suffer “cardiac arrest”

• CIRCULATION / Early CHEST COMPRESSION

2. Render initial, 30 chest compressions

3. Open an unconscious patient’s airway, place one hand on their forehead

• Jaw Thrust Maneuver

• METHODS OF RESCUE BREATHS

• CHARACTERISTICS OF GOOD CPR

• AED – Automatic External Defibrillator

• Give ONE shock each time AED advises “SHOCK”

J. CONTINUE RESUSCITATION UNTIL

K. THE RECOVERY POSITION

PRE-SELECTED VIDEO FOR CPR:

PART I: SKILLS CHECKLIST ON CARE MODALITIES:

ASSESSMENT CRITERIA CD ID ND REMARKS

ASSESSMENT CRITERIA CD ID ND REMARKS

Performed by: Evaluated by:

PART III: PEER - GROUP EVALUATION

Name Participation Cooperation Quality of Work TOTAL

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Class Schedule / Section: ______ Date: _